Pain relieving effect of thermoplastic lumbosacral orthosis with adjustable posterior pad in chronic non-specific low back pain.

reduced abnormal pressure, reduced muscle fatigue and increased proprioception. 5,6 People with flat back developed several compensatory mechanisms to maintain an efficient gait and decreased joint damage, but these safeguards failed over the time. Flat back of orthosis not only caused backache, abnormal posture and abnormal body mechanics, but also compromised the stability of gait and function of the knee and hip joints. 7 So, preservation of physiologic lumbar lordosis was an important consideration during performing fusion of the lumbar spine. 8 In case of the present orthosis, setting of the lumbar lordosis, charac-terized for each individual, in a special position may have a pain relief effect on patients with non-specific LBP. Insignificant change of LLA and LSA after using orthosis showed functional effect of orthosis on the spinal column, instead of anatomical changes. The present study results were affected by some potential limitations, which were only male patients, lack of a control group and short period of follow-up. For confirming, further studies on the large number of patients for a longer period of observation may be needed. Preliminary results of this study showed that using thermoplastic lumbosacral orthosis with adjustable posterior pad may have a pain relieving effect on patients with non-specific LBP and may improve their quality of life.

The thermoplastic lumbosacral orthosis with a posterior adjustable pad, used in present study, had three parts (Figure 1). This adjustable pad could be moved and located in the desired lordotic positions regarding different tensions on the straps with the advantage include low weight and being comfortable. After adjusting the orthosis, patients were asked to have their usual activities such as walking and going up and down stairs for 30 minutes. Patients who did not have any problem during this 30 minutes, were asked to use the orthosis for the next five days during which they kept their usual daily activity and did not use any type of medication.
The severity of pain was measured using a modified visual analog scale (VAS) scoring method. A VAS is a 10 cm horizontal line ranged from no pain to severe pain. The patient marked the point that he felt representing his perception of current state. Patients' LBP severity was assessed by using VAS at baseline (VAS-A) and 5 days (VAS-B) after using fitted lumbosacral orthosis. At the times of assessing VAS-A and VAS-B, a single standing lateral radiograph without orthosis was obtained from the lum- Then, general linear model repeated measures test was used to assess the difference after using orthosis. A p value less than 0.05 was considered significant.
The LLA before and five days after using orthosis was respectively 45.44±7.07 and 47.20±6.29 degrees which did not significantly change. The LSA before and five days after using orthosis was 37.68±4.26 and 38.96±3.78 degrees, respectively, showing insignificant changes. VAS scores five days after application of orthosis, in comparison to the baseline scores, showed a significant decrease. In the present study, a different type of orthosis was used (thermoplastic, light and comfortable in nature; Figure 1). This type of orthosis may be produced in different sizes and pre-production forms may be prescribed for every single patient.
Several mechanisms were suggested for the pain relieving action of lumbosacral orthosis including motion restriction/decreased weight load on the spinal column, reduced abnormal pressure, reduced muscle fatigue and increased proprioception. 5,6 People with flat back developed several compensatory mechanisms to maintain an efficient gait and decreased joint damage, but these safeguards failed over the time. Flat back of orthosis not only caused backache, abnormal posture and abnormal body mechanics, but also compromised the stability of gait and function of the knee and hip joints. 7 So, preservation of physiologic lumbar lordosis was an important consideration during performing fusion of the lumbar spine. 8 In case of the present orthosis, setting of the lumbar lordosis, characterized for each individual, in a special position may have a pain relief effect on patients with non-specific LBP. Insignificant change of LLA and LSA after using orthosis showed functional effect of orthosis on the spinal column, instead of anatomical changes.
The present study results were affected by some potential limitations, which were only male patients, lack of a control group and short period of follow-up. For confirming, further studies on the large number of patients for a longer period of observation may be needed. Preliminary results of this study showed that using thermoplastic lumbosacral orthosis with adjustable posterior pad may have a pain relieving effect on patients with non-specific LBP and may improve their quality of life.